The role of ultrasound in the diagnosis and follow-up of early inflammatory arthritis

Abstract

0009-9260/$ e see front matter 2011 The Royal Co doi:10.1016/j.crad.2011.07.047 Spencer et al.1 present a comprehensive pictorial review of the role of musculoskeletal (MSK) ultrasound in the diagnosis and follow-up of patients with early inflammatory arthropathies. This cohort of patients can be difficult to investigate and manage, with diagnosis hinging on the detection or exclusion of erosions, synovitis and bone oedema (where erosions are not yet apparent) and where the emphasis is increasingly on early intervention with powerful disease-modifying therapies once an inflammatory diagnosis has been established.2 Therefore, imaging can occupy a pivotal role in management of such patients. However, the limitations of conventional radiography alone have long been recognized.3 Gadolinium-enhanced magnetic resonance imaging (MRI) is a highly effective imaging tool for the diagnosis of early inflammatory arthritis,4 but is expensive and access is limited. The performance of MSK ultrasound in the detection of synovitis and erosions has proved highly satisfactory,5,6 although bone oedema cannot be assessed. MSK ultrasound is becoming increasingly available in the UK, with most hospital imaging departments now offering a service; although frequently this primarily supports orthopaedics and particularly shoulder surgeons. Rheumatologists